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Stigma and Anxiety Disorders: The Double Whammy

Stigma has been noted as a “hidden burden” in mental health problems. But what does this mean? A burden is a heavy weight that is difficult to carry. People with anxiety disorders carry this weight in many ways – psychologically, financially, relationally, occupationally, and physically – but also silently due to stigma. Despite the significant worldwide prevalence of anxiety disorders (28% lifetime occurrence), few people know about it. Anxiety in particular is a hidden disorder, by its internalizing nature. We can’t “see” anxiety, and because everyone has some amount of anxiety, others find it difficult to understand how overwhelming anxiety symptoms can interfere with day-to-day activities. Thus, people with anxiety experience a double dose of burden due to 1) stigma and 2) having an invisible condition.

As former Canadian Medical Association President Dr. Brian Day states, “In some ways, mental illness is the final frontier of socially-acceptable discrimination.” People have a tendency to fear, discriminate against, or dismiss what they don’t understand. In our society, mental health problems continue to be viewed as a personal mark of disgrace or weakness. How do we know these attitudes exist? A 2008 study on attitudes towards mental health problems revealed:

Almost half of Canadians think people use the term mental illness as an excuse for bad behaviour.

One in four Canadians are fearful of being around those who suffer from serious mental illness.

Half of Canadians would tell friends or coworkers that they have a family member with a mental illness, compared to 72 per cent for a diagnosis of cancer or 68 per cent for diabetes.

Most Canadians, 61 per cent, would be unlikely to go to a family doctor with a mental illness, and 58 per cent would shy away from hiring a lawyer, child-care worker or financial adviser with the illness.

In another survey, the public sees family members, especially parents, as being responsible for a relative’s mental illness.

And from another study, 10-50 % of parents, mostly mothers, have concerns about being blamed for their child’s mental illness.

The influence of stigma starts early, too. Mitchell-Lowe and Eggleston found that children as young as 7 years old identified themes including stigma and anxiety about attending the mental health out-patient services. Recently other researchers have found that by reducing stigma in school programs increases positive behavior, and that students in schools did not feel particularly stigmatized when participating in mental health programs in schools. This difference between how services are offered in the community and services offered at schools has been investigated for the last decade. Increasingly schools are moving towards including mental health education and intervention in classrooms, under the umbrella of Health Literacy. Similarly to other prevention programs implement with school children regarding social-emotional topics (e.g., sexual health, drug abuse and prevention), mental health identification and skill management training are becoming more popular. Teachers report wanting skills to work effectively with anxious children, but no pre-service teacher training program mandates social emotional skill development for teachers. Veteran teachers claim mental health issues in their classrooms are overwhelmingly their biggest concern…and yet are not trained to intervene properly, whether this be accurate referral to other professionals, early intervention for children with low level symptoms, or school-wide training in mental health concerns. Perhaps stigma is what continues to keep, in part, mental health literacy absent from teacher training programs in North America.

Effective treatment for anxiety makes a difference in the lives of those who suffer from anxiety disorders. Yet the idea of seeking professional help remains one of the greatest burdens to accessing care. In Canada, there are several associations committed to helping reduce the burden of stigma by advocating for awareness, prevention and treatment of anxiety disorders. For more exciting work on reducing the stigma, in particular around anxiety disorders, visit www.anxietycanada.ca or http://www.anxietybc.com and http://www.mentalhealthworks.ca/facts/sheets/stigma.asp